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Evaluation of Minnesota health insurance network adequacy

Evaluation of Minnesota health insurance network adequacy. Jil Pavagadhi & Jennifer Schultz. Background. US spends 17% of the GDP on health care, approximately $3 trillion Minnesota spent about $39.8 billion in 2012 (MN Dept. of Health) Access is limited to persons with

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Evaluation of Minnesota health insurance network adequacy

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  1. Evaluation of Minnesota health insurance network adequacy Jil Pavagadhi & Jennifer Schultz

  2. Background • US spends 17% of the GDP on health care, approximately $3 trillion • Minnesota spent about $39.8 billion in 2012 (MN Dept. of Health) • Access is limited to persons with • Insurance through employer/ exchange • Government sponsored program • Private insurance/ care • Safety-net provider

  3. Background • Narrow Network plans are becoming popular (50% of marketplace offerings) • Drive down overall cost of healthcare • Lower premiums • Plans too narrow to offer care in a timely manner with additional issues (22%) • Decreasing over time (2015- 15 Networks  2017- 12 Networks) • Minnesota geographic access standards • 30 minutes/miles for primary care, mental health, & general hospital services • Waiver

  4. Research Objective • To evaluate the health insurance network adequacy in Minnesota for specific “Provider Specialties” (child psychiatry, psychiatry, neuropsychology, mental health nurse practioner & mental health clinical nurse specialist ) and several “Provider Types” (licensed independent clinical social worker, licensed psychologist, licensed professional clinical counselor (LPCC), chemical dependency provider- inpatient/outpatient). • The results will provide information to MN agencies & legislatures

  5. Approach • Data standardization and analysis • 37 insurance plans offered in 2017 • Excel • Mapped and drew out 30 min/mile polygons • 700- 78,000 provider locations per plan • With about 98-100% precision • ArcGIS

  6. Results • ~41% of plans are insufficient (15/37) • HealthPartners, Medica, Sandford Health • Most of them had spec 21 and 81 not available

  7. maps

  8. Conclusion • First time, cross checked by a third party • Network inadequacy clearly visible • Concern for patients and families with out adequate access to care • Networks are becoming more narrow • Possible reasons: • Insufficient mental health providers in Minnesota? • Plans are not adequately reimbursing providersand thus providers are not participating in networks.

  9. Future Work • Dental providers • Other specialty & provider types • Improve network adequacy requirements • Audit carriers • What specialty or provider type do you recommend researching next?

  10. References • http://www.health.state.mn.us/divs/hpsc/hep/publications/costs/healthspending2014.pdf • http://www.health.state.mn.us/divs/hpsc/mcs/networkadequacy.htm • http://www.ncsl.org/research/health/insurance-carriers-and-access-to-healthcare-providers-network-adequacy.aspx • http://www.house.leg.state.mn.us/comm/docs/cf5f0d04-f6e5-449c-9533-402bd2a20256.pdf

  11. THANK YOU!

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